HomeMy WebLinkAbout2016 Apr 22 - Sign Off Transmittal Sheet, Plans - Sunroom o�.��ak TOWN OF YARMOUTH
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�� ��`-,� HEALTH DEPARTMENT
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��'' ``��� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
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To be completed by Applicant:
Building Site Location: C.� ( NG'�D I�(�
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Proposed Improvement: J�UN2pol�/ l¢.bDiTO� � �� �X{�T�1 C� �� '
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i Applicant:��i� g ���r,�6 Tel. No.:�-3!0'1- C7�Z � �
Address: 2D r'f'dt�t / �M� � v'.��iJN��S Date Filed: !����'�6
**If you would like e-maid notafication of sign off,'please provide e-mail address:
Owner Name: �f� tt�-5��1
Owner Address: �`� /�"1�DNd`'�O� � � �h,�G�U'�i( Owner Tel. No.:
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RESIDENTIAL AND/OR COMMERCIAL BUILDING
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HEALTH DEPARTMENT�: l5etermines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
Please submit three (3) copies of plans, to include:
(l.)� Site Plan showing existing buildings, water line location,
and septic syst�m location;
(2.) Floor plan labeling ALL rooms within building
(all existing and proposed) —
Note:Floar plans not required for decks,sheds, windows, roofing;
(3.) If necessary, Title 5 app'�ication signed by licensed installer
with fee.
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REVIEWED BY: � DATE: ` ���"�� '�'
PLEASE NOTE
COMMENTS/CONDITIONS:
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HEALTH DEPT.
HASKELL RE5IDENGE
14'
29 MONOMOY ROAD �,�,,,
50UTH,YARMOUTH, MA 02664 � i
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PROP05ED FLOOR PLAN
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1tlORTGAGE'' IN,S'P�'CTICJN PLAN
APPUCA�tT: HASKELL TOWN: SOUT1-I YAftMOUTH '�
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